M MOHD SLIM 1, H LALA , N BARNES , R MARTYNOGA
1Waikato Intensive Care Unit, Hamilton, New Zealand
Aim: Describe ethnic inequity in the RRT-requiring population in our ICU
Background: Māori in New Zealand (NZ) are disproportionately affected by chronic kidney disease (CKD), and experience lower life expectancy on community dialysis compared to non-Māori. We previously identified higher renal replacement therapy (RRT) requirement for Māori in our intensive care unit (ICU), which is the tertiary referral centre for NZ’s Te Manawa Taki region.
Methods: Retrospective audit of the Australia and NZ Intensive Care Society database for all adult admissions to our general ICU from Te Manawa Taki between 2014-2018. Patients were stratified by non-RRT requirement (non-RRT), RRT-requiring acute kidney injury (AKI-RRT), and RRT-requiring end-stage renal disease (ESRD).
Results: Relative to the Te Manawa Taki population, Māori were over-represented across all strata, especially ESRD (61.8%), followed by AKI-RRT (35.0%), and non-RRT (32.4%) (p<0.001). AKI-RRT, overall, had highest in-ICU mortality (31.2%), followed by ESRD (18.0%), and non-RRT (14.7%) (p<0.001). ESRD, however, had highest 1-year mortality (46.1%), followed by AKI-RRT (43.1%), and non-RRT (24.5%) (p<0.001). We did not identify ethnic inequity in mortality outcomes within any stratum. In-ICU mortality was similar by ethnicity amongst AKI-RRT (30.8% amongst Māori, vs 31.5%, p=1.000), and ESRD (16.4% amongst Māori, vs 20.6%, p=0.826). This trend remained at 1 year.
Conclusion: Increased RRT requirement amongst Māori in our ICU is due to higher representation amongst ESRD. AKI-RRT overall had higher in-ICU mortality than ESRD, but this reversed at 1-year. There was no ethnic inequity in mortality measures across all strata.
The presenter is an advanced trainee in nephrology (Royal Australasian College of Physicians) and adult intensive care (College of Intensive Care Medicine) based in New Zealand.